Journaling as Therapy for Veterans

November 19, 2013

"War stories" has come to mean a personal experience where hardship or danger might be involved, rather than a soldier's firsthand account of a horrific combat experience. Today, a growing number of soldiers and veterans who write down their stories and engage a counselor in the process are experiencing catharses.

The use of writing and journaling as a form of therapy is well documented scientifically, but it is still a relatively new approach for community providers who are helping today's veterans manage their memories, explains Nadine Bean, associate professor in West Chester University's graduate social work program. She has used journaling in both teaching and in practice for more than 25 years, understands its value, and knows how to incorporate it into the healing process in a therapeutic setting.

"It seems counterintuitive" for veterans to revisit painful segments of the past, she admits, "but because you're telling the story more than once, the meaning and impact of the story shift as we gain a deeper understanding. The mental health professional supports the veteran and the story can lose its powerful negative grip on his or her life."

Bean has discovered that many community providers are hungry for training that helps veterans heal through creative expression, especially narrative writing.

She and Ray Facundo, an Iraqi war veteran (two deployments) who earned his master's of social work at WCU this May, have been traveling the country making presentations to behavioral healthcare professionals "on using the narrative approach – journaling and PhotoVoice – in teaching and learning about work with veterans and military families and in helping veterans heal."

The popularity of her presentations is a testament to the need for such training for community providers, including social workers, counselors, doctors and nurses. "A low percentage of licensed mental health professionals are trained in addressing veterans' behavioral health needs, as well as in using the narrative approach to facilitate healing," Bean notes.

As a result of one presentation she made this fall with Facundo, who is now the Veterans Services Coordinator at Portland State University (Oregon), "He and I were asked to present at a veterans services conference at St. Leo University in Florida in June 2014 and to submit an article to a journal on using creative approaches to helping veterans in their transitions back home."

Bean says there are several factors that make today's veterans of the Iraq and Afghanistan wars unique, besides the fact that they served in the longest of America's wars: Many have seen multiple deployments; their "signature" injury is mild traumatic brain injury (TBI) – concussion – and many have been in or near more than one IED (improvised explosive device) blast, with cumulative traumatic effects on the brain; and nearly all the troops are volunteers.

"Never before has the country relied so heavily on the National Guard and reservists," Bean notes, adding that the Pennsylvania National Guard is one of the largest in the country (19,000 reservists). "These veterans and their families, who are not connected to a base like other active duty military members are, can feel isolated. They need support."

Her progressive course "Social Work with Veterans and Military Families: A Resilience and Trauma-informed Approach" fills that niche. In an intense format – five full days during one week of West Chester's winter term – it offers graduate students and community providers the tools to support veterans and their families. Bean addresses innovations in behavioral health and social services to veterans and military family members including: building resilience, suicide risk assessment and prevention, assessment and treatment of military sexual trauma, assessment of family violence and child maltreatment in military families.

And she incorporates creative expression. One emotional component comes at the conclusion of the course, when she shares photos from the Philadelphia Veterans Administration-funded 2012-13 PhotoVoice project" From War to Home: Through the Veteran's Lens." Forty veterans of the Iraq and Afghanistan wars – including Facundo and several other WCU student veterans – were given cameras and the opportunity to share their story in pictures and captions. The resulting exhibit that anthropologist and principal investigator Gala True curated provides a window into the impact of military service on health and the stress of transitioning back to civilian life.

Bean is reaching the community behavioral and mental health practitioners who are directly in touch with today's veterans through her presentations and the winter term course, which is being offered for the third time this January. And those professionals are reaching veterans to help them heal by finding their storytelling voices.

Nadine Bean has been on the WCU graduate social work faculty since 1998. She has been a volunteer for the American Red Cross, Service to the Armed Forces division, for more than 10 years and is a trainer for the Red Cross in psychological first aid for military families. Bean is on the national board of The Soldiers Project, a nonprofit network of licensed mental health professionals who provide free, confidential and unlimited psychotherapy for military service members, veterans and their loved ones. She has expertise in the use of a narrative approach to understand diverse populations and is experienced in child welfare. She was also president of the National Association of Social Workers, Pennsylvania Chapter from 2005 to 2007 and earned the chapter's Lifetime Achievement Award in 2011.